Optimal Insufflation for Natural Orifice Translumenal Endoscopic Surgery (NOTES)

概要

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Natural orifice translumenal endoscopic surgery (NOTES), in its "pure" form without assistant use of any transabdominal cannulae, will require fast and steady insufflation of both intraluminal and intraabdominal spaces through a flexible gastrointestinal endoscope. The use of rapid absorptive carbon dioxide (CO<SUB>2</SUB>) as an insufflating agent, is strongly recommended from the initial step of NOTES, since conventional insufflation using atmospheric air may cause prolonged distension of the downstream bowel and subsequently obstruct the intraabdominal surgical exposure. A dedicated CO<SUB>2</SUB> insufflator for flexible endoscope (UCR, Olympus) has recently become available in the market. The UCR, however, willnot be applicable for NOTES, since the intraabdominal pressure may be fluctuated with manual " on-and-off" insufflation. The insufflation may be too slow to perform advanced NOTES procedures, even when using a pressure controlled surgical insufflator. This is simply because the insufflation channel of endoscope is much narrower than the standard insufflation tube. A modified insufflation system specifically designed for NOTES is therefore considered indispensable. A continuous R & D effort, together with meticulous basic/clinical research, is needed to bring this cutting edge technology in the minimally invasive patient care.
日本コンピュータ外科学会の論文